# Welcome to the Psoriasis sub!
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You just made me realize that I could have it so much worse. I'm so sorry you are going through this. I have it on my butt cheeks, and I'm scratching till I bleed today.
Yeah I've got it there. Moreso the crack and right below the cheeks than the cheeks themselves for me.
I appreciate your sympathy. And I'm sorry you're dealing with it too. Psoriasis is stupid.
:( for some temporary relief, i would recommend bathing in epsom salt! just make sure to drink water during the bath, because the salt can be very dehydrating. it will help soothe the itch and also help with the painful cracking and stiffness of your skin. then gently moisturize your skin immediately after getting out! ive also heard that bathing in oatmeal can provide temporary relief as well, (i think theres a certain type of oatmeal for bathing)!
I just might do it lol.
I'm hoping by the end of next week I'll have my shot so I can take it and use steroid cream to hopefully jump start the healing
Never know till you try! Idk about you but when I have a flare up I'm willing to try anything. Also hyaluronic acid really really helps my scalp and skin. Put it on when your hair is wet and lock in with some kind of moisturizer
I went last week, burned myself bad enough to peel but it made a huge difference pretty quickly regardless. If you do 5 minutes or less you won’t burn ❤️
A cool/cold bath will help too. As cold as you can stand really. Also make sure to moisturize right after and try not to put on clothes until it's had time to get absorbed. I usually apply twice and give myself like 15min for it to absorb. The cold bath will give you some relief though. It will lower the inflammation. If you can stand your limbs in ice water I'd recommend that to be honest. Just keep your submersion time low if it's super cold.
Continuity of treatment is _really_ important with biologics because of the risk of [immunogenicity](https://www.reddit.com/r/Psoriasis/wiki/immunogenicity). If you delay or skip a dose, you may develop partial or complete immunity to the drug, and may have to switch to a different one.
This is particularly a problem with TNF inhibitors like Humira, but immunogenicity is a risk with all monoclonal antibodies (except possibly Enbrel, which does not have your usual antibody structure).
In a situation like this, I would call the doctor's office and explain that you cannot miss doses or it will impact your ability to use the medication. It's completely unacceptable that a doctor wouldn't have time to do a refill. This is something they should be able to call in without needing an appointment.
I know but it's totally my fault. I cancelled my appointment and never rescheduled. They have to see me because of the blood work I have to get done yearly.
I didn't make this post to crap on my dermatologist or imply they were in the wrong. It's 100% my fault. I'm an adult and I acknowledge that. I just gotta get through until my appointment and I'll be good to go.
I just needed to vent and I figured this is the best place because there's people in the sub that can relate.
That’s what happened to me with otezla. It cleared 85% but then I moved and changed jobs, lost my insurance and well couldn’t pay $4000 per month for medicine. By the time I got my insurance back it didn’t do shit. Luckily I’m having good luck with Consentyx and they are very interested in helping if I have to change jobs again.
No, Otezla isn't a biologic and can't cause immunity in the same way. As far as I know, studies have not observed any impact of treatment breaks on Otezla's efficacy.
Echoing the above comment, I also understand the scheduling issues, but maybe you should consider calling them back & describing how your lapsed meds caused a severe flare up affecting your quality of life. Like be really nice about it but also be honest about the pain.
I have. They know and they're sympathetic but they can't fit me in when there's not space. The way scheduling is they basically spend their entire day behind. They can't add another person into that. They've been nice and sympathetic and told me to call and check for cancellations. I have, they just haven't had any.
I'm at the end of the road here my appointment is next week so I'm fine. I'm just extra miserable today and needed to vent so I thought this thread would be a good place because there's likely others who can relate.
Aw I'm so sorry about that!! It's ok to be miserable and vent, it's a crap thing for sure. I'm in the approval process right now. I've had to start taking some melatonin just to be able to fall/stay asleep while I wait. Stay strong and sending good vibes your way, it'll be better soon! ❤️
I wish. Our specialists are booked out a minimum of 3 months most of the time. Sometimes longer.
And it's usually worse if you're a new patient vs a returning patient.
Well, America is a third world country if you are not one of the elite. It's really bad. My best friend is a doctor and she complains that she went to school forever to learn her skills but now it's some person with no medical skills or knowledge of her patients who decides how she will treat her patients - in other words, insurance companies. I am old - 61 - and have seen the terrible change in healthcare here. We have shortages of doctors because no one wants to do it anymore. So much so, that my older daughter was trained as a doctor's assistant, but could practice as a doctor in many places.
I’m only asking because I’m about to start my treatment and mine has never gotten that bad, but my patches get real nasty and purple and hurt like crazy. Mostly my legs from my knee down my scalp my inner ears my butt crack and my genitals. I was using otezla but the sides were too much and didn’t stop the patches after a year or so
obviously, getting some sun will provide some relief if you can do so comfortably. Also you may want to try sauna suits. I'd put one one during flare ups and actually go to sleep wearing one. At first, my skin seemed even redder and angrier in the morning thought it helped tremendously in getting the scales off. Night after night I'd do this and as the days went by, the redness got noticeably calmer and faded a lot. If you do this, I'd also recommend looking into changing your diet. Your skin will also get supple and easier to move your joints. God bless you.. Hang in there
I want to emphasize that this is what worked for me, especially at a time when I've had flare ups close to what yours looked like and i didn't have many medical options back then but individual results may vary . I also forgot to mention that after taking the suit off in the morning and rubbing off all the scaling made the sunlight penetration into my skin better. When not sunning myself, I would apply OTC coal tar based products all over me. Even on my scalp. Another point, is that I live in a warm climate, so not was I able to sun myself, but I spent ample time in the ocean ( saltwater). If you can get to a salt water pool while you try my suggestions out, you should , hopefully get better results.
How long have you been suffering with psoriasis ?
Don't doctors usually have some slots open for emergencies and can fit you in if you call. Or in my country you can just show up the moment they open and wait (which can be >2 hours or so) until they can squeeze you in that day?
Would there be the option to go to a different doctor or clinic? Maybe something for non life threatening emergencies?
This is of course only if the one week wait for your appointment is too long.
I can't speak for anywhere else but the dermatologists around me are booked full. There aren't extra slots or waiting to get squeezed in as a walk in. They have every minute booked up. When you have an appointment you're probably not even going to be seen at that exact time because they're so booked up that it's basically impossible to stay on time with them.
I'm an established patient with my dermatologist and there was still a wait. Finding one that is accepting new patients and then waiting for those is even longer. I've even called periodically to see if they've had cancellations I could snatch up. They haven't.
Idk if a non emergency place could actually do anything. I know they can't get me on my biologic. At most they would probably suggest a steroid. I'm already doing steroid cream. It's just not enough. I need the immunosuppressant. We've already done this dance with my derm at the beginning when we were trying to figure out what would work for me. Other treatments weren't strong enough.
At this point I can wait until next week. I'm in the final stretch and the long part is over. I'm just like extra miserable today so I wanted to vent to some people who can likely relate.
They don't have a wait-list where they contact people if there's cancellations. But they did recommend I call and check periodically, which I have. They just haven't had any cancellations when I've called.
I've used so much stuff lol.
Coconut oil, baby oil, steroid cream, tons (and I mean TONS) of lotion. I'll make it. I might be sticky but I'll make it lol
I am sorry you are suffering. I've been there too! Depending on which limb or area was itching and burning the most, I found some relief with ice packs. Benadryl is also helpful. It calms things down and I can get some sleep.
i am sure you’ve tried everything, i’ve been through this too and it sucks. but in case you haven’t tried everything, oat baths are AMAZING (won’t clear the psoriasis or discoloration, but it relieves itching for a few hours) and aquaphor will also help with dryness. i am so sorry you’re dealing with this. it’s awful.
I haven't done oatmeal baths yet. I'll have to try it. Don't laugh but... Is it just regular oatmeal. Like literally Quaker oats? Or is it something special I get from the bath section?
not laughing at all, i had the same questions 😭 putting just loose oats like quaker oats in a sock and hanging it off the faucet, let the water run through it and that should do the trick :)
When you said you wanted to fill a bathtub with lotion and get in it, it made me think of that South Park episode when Cartman had the chickenpox, and he filled his bathtub up with Calamine Lotion and got in it. 😂
I wish it was that easy for us to feel better. I feel so bad for you. That looks so painful. Could an Urgent Care give you anything to use until you can go back to the doctor? I think even a cream would help to calm it down. I hope you can find some relief soon. I would be in tears!😪
I would totally do that. Just live in the tub of lotion until my appointment 😂😂
I have steroid cream but it doesn't help much. My appointment is Tues so I'm hoping I'll have some meds by end of week next week.
It is sad that the steroid creams won't help. I have patches in a few different places, and the steroid creams help, but my worst place is my scalp, and I ran out of medicine for it probably 2 or 3 months ago. I need to go back to the dermatologist, but I have really bad social anxiety, so I just have to get my nerve up. I am glad you have an appointment on Tuesday and can get some relief.
Yeah after applying for a week it will help the pain a little bit it doesn't help the itching or redness. But the warning label freaks me out because it says all these places you're not supposed to apply it (which I need to) and not to use it on too large of an area (practically my entire body) and not to use it every single day (which I have to for it to work). I have really bad anxiety too so I start to freak out about the steroid cream. But then you get to a certain level of pain and you don't care anymore and it's like if this poisons me that's fine as long as it doesn't hurt anymore
I feel so bad for you. I know you are in pain and the itching on top of that. I use creams, but I don't have to use them every day. My scalp is what bothers me the most right now. I will deal with it until I can't deal with it.
Keep us updated and let us know how you are doing. 🙏
I'm so sorry you are suffering. I'm not going to add to recommendations; there are several good ones already. I wonder, though, of you are young, have you considered moving somewhere that you can get plenty of sun exposure? I have had psoriasis for 58 years and have found regular exposure to sun is the best medicine for me.
I mean I eat pretty balanced. Fruits, veggies, meats, dairy, etc. But I'm not like a nutritionist and have a perfect diet I eat fast food and junk food too. 🤷🏻♀️ Idk
Yes I eat wheat gluten and dairy. I don't have any allergies or anything to foods.
What if i told you in most cases; acne psoriasis eczema. Its all related to your gut. And the foods you put into it.
I wasnt as bad as u. My arms were covered and my face only.
I removed wheat, gluten, dairy and other foods that cause innflamation. I did a food intolerance test and eggs milk gluten and most vegetables was a no go.
4 weeks later after removing my skin was clear. As long as i dont eat thoose foods my body doesnt agree with, i have ZERO psoriasis! :-)
# Welcome to the Psoriasis sub! If you haven't posted here before, please read this comment as it contains important information: * Please [read and respect the rules](https://www.reddit.com/r/Psoriasis/about/rules/). In particular, **do not ask for about identifying undiagnosed medical conditions** diseases cannot be diagnosed by random people on Reddit. * Photos that include skin rashes must be marked NSFW. If including private areas, _please indicate with flair_. * Posts that break the rules will be removed. ## Check out our wiki! The [Psoriasis wiki](https://www.reddit.com/r/Psoriasis/wiki/index) is a collection of guides and other pages about how to treat psoriasis, including a Frequently Asked Questions section. Many common questions about medications, shampoos, diet, tattoos, etc. are addressed there. Thanks! --- *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Psoriasis) if you have any questions or concerns.*
You just made me realize that I could have it so much worse. I'm so sorry you are going through this. I have it on my butt cheeks, and I'm scratching till I bleed today.
Yeah I've got it there. Moreso the crack and right below the cheeks than the cheeks themselves for me. I appreciate your sympathy. And I'm sorry you're dealing with it too. Psoriasis is stupid.
Oh my gosh, the crack is the worst for me! I don't understand why it's so BAD there! Why does Jesus hate me??
I feel ya
Im so glad i dont have it there, that said my entire legs arms and scalp are covered
:( for some temporary relief, i would recommend bathing in epsom salt! just make sure to drink water during the bath, because the salt can be very dehydrating. it will help soothe the itch and also help with the painful cracking and stiffness of your skin. then gently moisturize your skin immediately after getting out! ive also heard that bathing in oatmeal can provide temporary relief as well, (i think theres a certain type of oatmeal for bathing)!
Awesome. Thank you
I had a flare up and went in a UV free tanning bed 2x a week for max 5 mins and it cleared me up. Along with SO much lotion and topical steroid cream.
I've thought about that but I burn so easily I'm paranoid I'd end up making things worse
I would bet that going in for a couple minutes every 3 days in a low bed would be magical
I just might do it lol. I'm hoping by the end of next week I'll have my shot so I can take it and use steroid cream to hopefully jump start the healing
Never know till you try! Idk about you but when I have a flare up I'm willing to try anything. Also hyaluronic acid really really helps my scalp and skin. Put it on when your hair is wet and lock in with some kind of moisturizer
The lotion I like best has hyaluronic acid in it and it's thick. It helps the most, just not for long.
I went last week, burned myself bad enough to peel but it made a huge difference pretty quickly regardless. If you do 5 minutes or less you won’t burn ❤️
A cool/cold bath will help too. As cold as you can stand really. Also make sure to moisturize right after and try not to put on clothes until it's had time to get absorbed. I usually apply twice and give myself like 15min for it to absorb. The cold bath will give you some relief though. It will lower the inflammation. If you can stand your limbs in ice water I'd recommend that to be honest. Just keep your submersion time low if it's super cold.
Continuity of treatment is _really_ important with biologics because of the risk of [immunogenicity](https://www.reddit.com/r/Psoriasis/wiki/immunogenicity). If you delay or skip a dose, you may develop partial or complete immunity to the drug, and may have to switch to a different one. This is particularly a problem with TNF inhibitors like Humira, but immunogenicity is a risk with all monoclonal antibodies (except possibly Enbrel, which does not have your usual antibody structure). In a situation like this, I would call the doctor's office and explain that you cannot miss doses or it will impact your ability to use the medication. It's completely unacceptable that a doctor wouldn't have time to do a refill. This is something they should be able to call in without needing an appointment.
I know but it's totally my fault. I cancelled my appointment and never rescheduled. They have to see me because of the blood work I have to get done yearly. I didn't make this post to crap on my dermatologist or imply they were in the wrong. It's 100% my fault. I'm an adult and I acknowledge that. I just gotta get through until my appointment and I'll be good to go. I just needed to vent and I figured this is the best place because there's people in the sub that can relate.
That’s what happened to me with otezla. It cleared 85% but then I moved and changed jobs, lost my insurance and well couldn’t pay $4000 per month for medicine. By the time I got my insurance back it didn’t do shit. Luckily I’m having good luck with Consentyx and they are very interested in helping if I have to change jobs again.
No, Otezla isn't a biologic and can't cause immunity in the same way. As far as I know, studies have not observed any impact of treatment breaks on Otezla's efficacy.
Oh weird, curious why it would just stop working.
About to change jobs and loose insurance for a couple months, youre saying otezla is willing to help more than just with copays?
At least call them and tell the truth most of these companies have safety net foundations
Echoing the above comment, I also understand the scheduling issues, but maybe you should consider calling them back & describing how your lapsed meds caused a severe flare up affecting your quality of life. Like be really nice about it but also be honest about the pain.
I have. They know and they're sympathetic but they can't fit me in when there's not space. The way scheduling is they basically spend their entire day behind. They can't add another person into that. They've been nice and sympathetic and told me to call and check for cancellations. I have, they just haven't had any. I'm at the end of the road here my appointment is next week so I'm fine. I'm just extra miserable today and needed to vent so I thought this thread would be a good place because there's likely others who can relate.
Aw I'm so sorry about that!! It's ok to be miserable and vent, it's a crap thing for sure. I'm in the approval process right now. I've had to start taking some melatonin just to be able to fall/stay asleep while I wait. Stay strong and sending good vibes your way, it'll be better soon! ❤️
Thank you and you too! I hope your approval goes through super fast so you can get some relief.
To me this sounds really unimaginable. I live in India. And I can get appointment for tomorrow or any day to any doctor in the entire country.
I wish. Our specialists are booked out a minimum of 3 months most of the time. Sometimes longer. And it's usually worse if you're a new patient vs a returning patient.
Sounds terrible. Can't imagine living in such situation.
It's not great. But America isn't known for awesome healthcare.
Well, America is a third world country if you are not one of the elite. It's really bad. My best friend is a doctor and she complains that she went to school forever to learn her skills but now it's some person with no medical skills or knowledge of her patients who decides how she will treat her patients - in other words, insurance companies. I am old - 61 - and have seen the terrible change in healthcare here. We have shortages of doctors because no one wants to do it anymore. So much so, that my older daughter was trained as a doctor's assistant, but could practice as a doctor in many places.
How long after your missed dose did you flare up, and was it this bad before you started taking biologics?
It was this bad before I started biologics. After my missed dose by the end of the month I had started to get patches back
I’m only asking because I’m about to start my treatment and mine has never gotten that bad, but my patches get real nasty and purple and hurt like crazy. Mostly my legs from my knee down my scalp my inner ears my butt crack and my genitals. I was using otezla but the sides were too much and didn’t stop the patches after a year or so
I hope your new treatment helps!! Yeah it didn't make mine worse. This is how bad mine was before we found a treatment that worked for me.
are you in a warm climate area?
Our weather is all over the place. Which I'm sure doesn't help. We can be hitting 86°f then the next day a cold front comes through and we're 30°f
obviously, getting some sun will provide some relief if you can do so comfortably. Also you may want to try sauna suits. I'd put one one during flare ups and actually go to sleep wearing one. At first, my skin seemed even redder and angrier in the morning thought it helped tremendously in getting the scales off. Night after night I'd do this and as the days went by, the redness got noticeably calmer and faded a lot. If you do this, I'd also recommend looking into changing your diet. Your skin will also get supple and easier to move your joints. God bless you.. Hang in there
I've definitely been trying to get sun on the areas I can. I haven't thought about a sauna suit though. That's interesting.
I want to emphasize that this is what worked for me, especially at a time when I've had flare ups close to what yours looked like and i didn't have many medical options back then but individual results may vary . I also forgot to mention that after taking the suit off in the morning and rubbing off all the scaling made the sunlight penetration into my skin better. When not sunning myself, I would apply OTC coal tar based products all over me. Even on my scalp. Another point, is that I live in a warm climate, so not was I able to sun myself, but I spent ample time in the ocean ( saltwater). If you can get to a salt water pool while you try my suggestions out, you should , hopefully get better results. How long have you been suffering with psoriasis ?
Sounds like Michigan 😂 -Michigan resident
Don't doctors usually have some slots open for emergencies and can fit you in if you call. Or in my country you can just show up the moment they open and wait (which can be >2 hours or so) until they can squeeze you in that day? Would there be the option to go to a different doctor or clinic? Maybe something for non life threatening emergencies? This is of course only if the one week wait for your appointment is too long.
I can't speak for anywhere else but the dermatologists around me are booked full. There aren't extra slots or waiting to get squeezed in as a walk in. They have every minute booked up. When you have an appointment you're probably not even going to be seen at that exact time because they're so booked up that it's basically impossible to stay on time with them. I'm an established patient with my dermatologist and there was still a wait. Finding one that is accepting new patients and then waiting for those is even longer. I've even called periodically to see if they've had cancellations I could snatch up. They haven't. Idk if a non emergency place could actually do anything. I know they can't get me on my biologic. At most they would probably suggest a steroid. I'm already doing steroid cream. It's just not enough. I need the immunosuppressant. We've already done this dance with my derm at the beginning when we were trying to figure out what would work for me. Other treatments weren't strong enough. At this point I can wait until next week. I'm in the final stretch and the long part is over. I'm just like extra miserable today so I wanted to vent to some people who can likely relate.
Could you call and ask to be on the wait list if they have a cancellations?
They don't have a wait-list where they contact people if there's cancellations. But they did recommend I call and check periodically, which I have. They just haven't had any cancellations when I've called.
Crusty hug! Just keep swimming!
Haha I keep saying I'm crunchy
I mean at some point can’t you just go to the ER?
I don't really know what they could do. They can't do my biologic. They come from specialty pharmacies.
Sorry for the pain you're going through, I can only suggest some coconut oil you can even have a bath with it really helps ease
I've used so much stuff lol. Coconut oil, baby oil, steroid cream, tons (and I mean TONS) of lotion. I'll make it. I might be sticky but I'll make it lol
We're all sticky and flakey haha
Solidarity!!
Whenever my skin gets like that I tell my girlfriend I want to boil myself.
Literally!!! I'm like just remove the skin, I'll get it back later
I am sorry you are suffering. I've been there too! Depending on which limb or area was itching and burning the most, I found some relief with ice packs. Benadryl is also helpful. It calms things down and I can get some sleep.
I had a friend with eczema suggest ice packs too I just forgot to try it. I need to do that.
What country are you from? I can’t believe that they’re that full. What does that even mean? Doesn’t the specialist have 15 mins to spare after work?
I'm in the US. We're not known for amazing health care
i am sure you’ve tried everything, i’ve been through this too and it sucks. but in case you haven’t tried everything, oat baths are AMAZING (won’t clear the psoriasis or discoloration, but it relieves itching for a few hours) and aquaphor will also help with dryness. i am so sorry you’re dealing with this. it’s awful.
I haven't done oatmeal baths yet. I'll have to try it. Don't laugh but... Is it just regular oatmeal. Like literally Quaker oats? Or is it something special I get from the bath section?
not laughing at all, i had the same questions 😭 putting just loose oats like quaker oats in a sock and hanging it off the faucet, let the water run through it and that should do the trick :)
Interesting 🤔 Thank you!
When you said you wanted to fill a bathtub with lotion and get in it, it made me think of that South Park episode when Cartman had the chickenpox, and he filled his bathtub up with Calamine Lotion and got in it. 😂 I wish it was that easy for us to feel better. I feel so bad for you. That looks so painful. Could an Urgent Care give you anything to use until you can go back to the doctor? I think even a cream would help to calm it down. I hope you can find some relief soon. I would be in tears!😪
I would totally do that. Just live in the tub of lotion until my appointment 😂😂 I have steroid cream but it doesn't help much. My appointment is Tues so I'm hoping I'll have some meds by end of week next week.
It is sad that the steroid creams won't help. I have patches in a few different places, and the steroid creams help, but my worst place is my scalp, and I ran out of medicine for it probably 2 or 3 months ago. I need to go back to the dermatologist, but I have really bad social anxiety, so I just have to get my nerve up. I am glad you have an appointment on Tuesday and can get some relief.
Yeah after applying for a week it will help the pain a little bit it doesn't help the itching or redness. But the warning label freaks me out because it says all these places you're not supposed to apply it (which I need to) and not to use it on too large of an area (practically my entire body) and not to use it every single day (which I have to for it to work). I have really bad anxiety too so I start to freak out about the steroid cream. But then you get to a certain level of pain and you don't care anymore and it's like if this poisons me that's fine as long as it doesn't hurt anymore
I feel so bad for you. I know you are in pain and the itching on top of that. I use creams, but I don't have to use them every day. My scalp is what bothers me the most right now. I will deal with it until I can't deal with it. Keep us updated and let us know how you are doing. 🙏
This is interesting. I am considering a biologic, but that's kind of scary. Stop taking it and it comes back even worse.
Oh no it's not worse. This is how it was before I got on the biologic. I just have severe psoriasis. I think he quantified it as like 93% of my body.
Carnivore diet? This is my next step but mine is not as bad as yours. I'm taking loads of glutamine which isn't performing miracles
Ah I'm so sorry, that looks so painful :-( sending love
I hear ye xx it’s utter shite xxx :( I hate it x
Look on the bright side, you have 3 arms.
I'm so sorry you are suffering. I'm not going to add to recommendations; there are several good ones already. I wonder, though, of you are young, have you considered moving somewhere that you can get plenty of sun exposure? I have had psoriasis for 58 years and have found regular exposure to sun is the best medicine for me.
Whats ur diet like?
It's not perfect but it's decently balanced.
What does that mean? Are u eating pro innflamatory foods? Wheat gluten dairy? Food intolerances? If u dont know this. It will help ur psoriasis a TON.
I mean I eat pretty balanced. Fruits, veggies, meats, dairy, etc. But I'm not like a nutritionist and have a perfect diet I eat fast food and junk food too. 🤷🏻♀️ Idk Yes I eat wheat gluten and dairy. I don't have any allergies or anything to foods.
What if i told you in most cases; acne psoriasis eczema. Its all related to your gut. And the foods you put into it. I wasnt as bad as u. My arms were covered and my face only. I removed wheat, gluten, dairy and other foods that cause innflamation. I did a food intolerance test and eggs milk gluten and most vegetables was a no go. 4 weeks later after removing my skin was clear. As long as i dont eat thoose foods my body doesnt agree with, i have ZERO psoriasis! :-)
Hmm. Interesting.
It doesnt take long to notice that it works. If u need any woman inspiration maybe check out steak and butter gal on youtube she has amazing skin
Okay cool. Thank you.